Infection Prevention eBug Bytes September 2015

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Infection PreventioneBug BytesSeptember 2015
Influenza Virus
2
UPMC Presbyterian ICU remains closed due
to mold

• There are no plans yet to reopen the
  cardiothoracic intensive care unit at UPMC
  Presbyterian after mold was found there two weeks
  ago. No surgeries have been canceled at the
  Oakland hospital and the cleanup continues, UPMC
  spokeswoman Wendy Zellner said Monday. She
  confirmed that on Sept. 3, a critical care
  medicine doctor discovered a male transplant
  patient had mold in an external wound. After
  opening up a wall nearby, mold was found and
  further investigation found mold in other areas.
• The entire 20-bed unit was closed Sept. 8, with a
  total of 18 patients moved to other parts of the
  hospital to get the intensive care they needed,
  Zellner said. The first patient was the only one
  with a confirmed association with the mold, she
  said.
• Even in otherwise healthy people, mold can affect
  health, according to a 2004 report from the
  Institute of Medicine, which found evidence that
  linked indoor exposure to mold with upper
  respiratory tract symptoms, coughs and wheezing.
• Working on the hospital cleanup are staff members
  in the infection prevention, facilities and
  housekeeping departments, as well as outside mold
  cleanup experts. Source http//www.epa.gov/mold/
  

3
Your mobile phone may be 'patient zero' for
hospital infections

• Infection preventionists, hospital staff and
  clinicians search high and low for weak spots in
  hospital-setting disinfection and cleanliness,
  but may need to focus more on what's in their own
  pockets, according to new research.
• In a paper published in the Journal of
  Occupational and Environmental Hygiene,
  Australian researchers sought to investigate the
  potential role mobile phones play as reservoirs
  for infection and bacterial colonization in the
  hospital setting.
• The researchers screened a group of 226 staff
  members comprising 146 physicians and 80 medical
  students at a regional Australian hospital
  between January 2013 and March 2014. They
  concluded that 74 percent of staff members'
  mobile phones were contaminated with bacteria, of
  which 5 percent was deemed potentially harmful.
  Similar organisms were found on the dominant
  hands of staff members.
• Junior medical staff members were found to be at
  greater risk for heavy microbial growth. Of the
  226 participants, 31 percent reported cleaning
  their phones routinely. Of those who cleaned
  their phones, only 21 percent reported using
  alcohol containing wipes. The researchers
  concluded that disinfection guidelines for cell
  phone use in hospitals should be developed and
  implemented.
• Source Journal of Occupational and Environmental
  Hygiene

4
Poor Contact Lens Hygiene Puts Users at Risk of
Serious Infections

• According to a recent CDC report, 99 of contact
  lens wearers in a survey reported having at least
  one questionable hygiene practice. The report
  noted that nearly a third of the 1,000 lens
  wearers who took the survey had experienced a red
  or painful eye requiring a doctors visit. An
  estimated 40.9 million adults in the U.S. wear
  contact lenses, according to the report. Wearing
  contact lenses increases a persons risk of an
  eye infection by about 10 times compared with
  people who dont wear contact lenses, and they
  are the cause of 30 of all corneal infections.
  Pseudomonas is often extremely inflammatory, with
  a sudden onset of redness, pain, tearing and poor
  vision.
• Sleeping in contact lenses is one of the most
  common ways people get the infections. Bacteria
  comes into the eye from the contact lens or lens
  case and can bind to the cornea, causing an
  ulcer. Experts say multiple bad habits often
  lead to trouble. Another common no-no is reusing
  old disinfectant solution when storing contact
  lenses in a case. Many people re-use the same
  solution for a few days, or top off each case
  with new solution. Experts recommend cleaning
  contact-lens cases every day and replacing them
  every three months. Cases should be rinsed out
  with disinfecting contact-lens solution and
  air-dried every day.
• Another source of eye infections is the parasite
  called Acanthamoeba, an invasive pathogen that
  can be found in all kinds of water sources,
  including swimming pools, tap water and fresh or
  saltwater bodies. Once on a contact lens, the
  pathogen can invade the eye and cause permanent
  vision loss and even blindness.
• Source Wall Street Journal

5





 
When should precleaning of flexible endoscopes occur?
Pre-cleaning of flexible endoscopes and accessories should occur at the point of use before organic material has dried on the surface of the endoscope, and before transport to the decontamination area. Flexible endoscopes, by virtue of the body cavities in which they are used, acquire high levels of microbial contamination during each use. Failure to completely follow the defined cleaning process, beginning with precleaning, has been shown to cause inadequate decontamination leading to patients being exposed to infectious agents. Precleaning of endoscopes and related equipment at the point of use before transport to the decontamination area helps prevent drying of the organic material on the flexible endoscope surfaces. To learn more, refer to the AORN Cleaning and Processing Flexible Endoscopes September 2015 www.aorn.org
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Study examines how to reduce infection risk in
pediatric playrooms

• As hospitals increasingly focus on improving the
  patient experience, many have considered allowing
  hospitalized children to receive sibling visitors
  in pediatric playrooms. Doing so requires special
  measures to reduce the risk of infection
  transmission, according to a study published in
  the American Journal of Infection Control. "Most
  guidelines recommend that siblings not be
  permitted to visit playrooms," wrote the study
  authors. "This approach was not seen as
  consistent with family-centered care in our
  setting."
• To make care more family-centered, the
  researchers conducted a literature review and
  reviewed current benchmarking strategies on
  playroom infection control standards. They also
  worked with members of patients' families, child
  life specialists, care teams and infection
  prevention and control services to develop a
  screening form for sibling visitors. The
  researchers' pilot project tracked the use of
  these forms for siblings and other visitors. In
  the first two years of the project, the screening
  form identified that approximately 10 percent of
  the visiting siblings had a potentially
  communicable illness. In the cases where the form
  revealed an infection risk, the family was
  informed that the visiting sibling would not be
  able to visit the playroom until his or her
  condition improved, "The lack of clear published
  strategies to screen siblings-visitors to patient
  play areas and the lack of knowledge sharing
  about experience in this area of infection
  prevention and control is a gap and should, we
  propose, be remedied," concluded the study
  authors. "Screening of siblings can reduce
  infection and allow hospitalized children to
  benefit from ongoing interaction.
• Reducing infection transmission in the playroom
  Balancing patient safety and family-centered care
  AJIC Sep 2015

7
AAP Mandatory flu immunization of health care
workers ethical, necessary

• The Academy has reaffirmed its support for a
  mandatory influenza immunization policy for all
  health care personnel (HCP) nationwide.
• Many individuals at high risk of influenza and
  its associated complications are in frequent,
  close contact with HCP because of their need to
  seek medical services. Therefore, immunization of
  HCP is a crucial step in efforts to protect those
  at risk of health care-associated influenza,
  according to the AAP policy statement Influenza
  Immunization for All Health Care Personnel Keep
  it Mandatory. The policy is available at
  www.pediatrics.org/cgi/doi/10.1542/peds.2015-2920
  and will be published in the October issue of
  Pediatrics.
• Mandatory influenza vaccine for all HCP is
  ethical, just and necessary to benefit the health
  of employees, their patients and community
  members, according to the policy. In addition,
  influenza immunization is cost-effective. The
  cost associated with influenza in the U.S. is
  estimated to be 87 billion per year, which
  includes medical care in outpatient and inpatient
  settings, work absenteeism and mortality.
• The Academy has developed guidance on
  implementing a mandatory influenza immunization
  policy that addresses supply, payment, coding and
  liability issues. These documents can be found at
  www.aapredbook.org/implementation

8
Active surveillance reduces SSIs after
neurosurgery 5 study findings

• Surgical site infections after neurosurgery can
  have devastating consequences, but active
  surveillance can reduce the likelihood of SSI
  risk factors being overlooked, according to a
  recent study published in the American Journal of
  Infection Control.
• Researchers conducted their prospective cohort
  study over a 24-month period in a university
  center. All total, nearly 950 adult patients
  undergoing neurosurgical procedures, with the
  exception of open skull fractures, were included.
• During the study period, the hospital established
  an active surveillance program with regular
  feedback and isolated specific microorganisms to
  identify independent risk factors for surgical
  site infections. Highlighted below are five
  findings from the study.
• 1) Of all the patients studied, 43 were diagnosed
  with an SSI, or 4.5 percent of the patients. 2)
  The researchers observed a significant reduction
  in post neurosurgical SSIs from 5.8 percent in
  2009 to 3 percent in 2010. 3) During the study
  period, the most common microorganisms isolated
  from SSIs were Staphylococcus aureus (in 23
  percent of the cases), Enterobacteriaceae (21
  percent) and Propionibacterium acnes (12
  percent). 4) The following independent risk
  factors were linked with postcranial surgery
  SSIs an intensive care unit stay of seven days
  or longer, a drainage that lasted three or more
  days and cerebrospinal fluid leakages. 5) For
  post spinal surgery, SSIs were linked with the
  following an intensive care unit stay of seven
  days or longer, a coinfection and a drainage that
  lasted three or more days. Ultimately, the
  researchers concluded that active surveillance
  with regular feedback is an effective
  SSI-reducing strategy and infection control
  measures that target the postoperative period are
  promising.

9
Infections Increase Death Risk by 35 for ICU
Patients, Study Finds

• Elderly patients admitted to intensive care units
  (ICUs) are about 35 percent more likely to die
  within five years of leaving the hospital if they
  develop an infection during their stay, a new
  study finds. Preventing two of the most common
  health care-associated infections bloodstream
  infections caused by central lines and pneumonia
  caused by ventilators can increase the odds
  that these patients survive and reduce the cost
  of their care by more than 150,000. The study
  looked at outcomes for 17,537 elderly Medicare
  patients admitted to 31 hospitals in 2002 to
  assess the cost and effectiveness of infection
  prevention efforts. Then, the researchers used an
  additional five years of Medicare claims data to
  assess the long-term outcomes and health costs
  attributed to health care-associated infections.
  While 57 percent of all the elderly ICU patients
  died within five years, the researchers found
  that infections made death more likely. For those
  who developed central line associated bloodstream
  infections, or CLABSI, 75 percent died within
  five years, as did 77 percent of those who
  developed ventilator-associated pneumonia, or
  VAP. Effective prevention programs for CLABSI
  resulted in an estimated gain of 15.55 years of
  life on average for all patients treated in the
  ICU, the study found. Source A decade of
  investment in infection prevention A
  cost-effectiveness analysis, AJIC Jan 2015

10
Hundreds of children tested after infection scare
at hospital

• More than 300 children have been tested for
  hepatitis and HIV infections in less than a week,
  after Seattle Childrens officials warned
  thousands of patients and families that surgical
  tools used at the hospitals Bellevue Clinic and
  Surgery Center may not have been properly
  cleaned. At least three of those children have
  posted what officials are calling false-positive
  results for hepatitis, testing mildly positive
  in an initial test, but then negative upon second
  review. More than 2,000 parents and family
  members have contacted the hospital since
  officials announced last Thursday that theyd
  detected lapses in cleaning protocol and were
  offering blood tests to children and young adults
  whod undergone day surgeries since the clinics
  opening in 2010.
• Some families have had children tested for
  hepatitis B and hepatitis C and for HIV at
  approved laboratories close to their homes, while
  others have been tested at the Seattle Childrens
  lab. Washington state health officials have
  launched an investigation into the potential
  infection risk, a process that could take several
  months
• http//www.seattletimes.com/seattle-news/health/hu
  ndreds-of-kids-tested-after-infection-scare-at-sea
  ttle-childrens/

11
Pneumonia Associated with an Influenza A H3
Outbreak at a Skilled Nursing Facility

• In December 2014, the Florida Department of
  Health, Bureau of Epidemiology, was notified that
  18 of 95 (19) residents at a skilled nursing
  facility had radiographic evidence of pneumonia
  and were being treated with antibiotics. Two
  residents were hospitalized, one of whom died. A
  second resident died at the facility. The Florida
  Department of Health conducted an outbreak
  investigation to ascertain all cases through
  active case finding, identify the etiology,
  provide infection control guidance, and recommend
  treatment or prophylaxis, if indicated. An
  outbreak-associated case was defined as the onset
  of fever or respiratory illness in a nursing
  facility resident or staff member from November
  29December 29, 2014. Overall, 50 persons,
  including 44 (46) residents and six (8) of 75
  staff members met the case definition. The
  earliest reported onset date was November 29 68
  of cases occurred during December 1218 (Figure).
  Antibiotics were prescribed to 36 (72) patients.
  Nine (20) ill residents were hospitalized. Two
  additional resident deaths occurred on December
  21 and December 22, for a total of four,
  increasing the fatality rate to 9 among
  residents meeting the case definition (n 44).
  All asymptomatic residents and staff were
  considered to have been exposed, and courses of
  prophylactic oseltamivir were offered to exposed
  persons on December 21 and December 22. The
  facility cancelled group activities, initiated
  droplet precautions, and stopped accepting
  admissions. Additional measures included
  implementation of respiratory precautions for
  visitors and exclusion of ill staff from work
  until 24 hours after symptom resolution. No cases
  were identified after December 21. Source MMWR
  September 11, 2015 / 64(35)985-986

12
Ebola Virus Disease Sierra Leone and Guinea,
August 2015 MMWRSeptember 11, 2015 /
64(35)981-984

• In August 2015, a medical student who did not
  report his Ebola exposure and did not adhere to
  contact follow-up procedures was admitted to a
  hospital in Conakry, where he shared a room with
  another patient. Before receiving a diagnosis of
  Ebola, the medical student was assisted by one of
  his roommate's visitors. When Ebola was diagnosed
  in the medical student, the roommate's visitor
  and his family could not initially be found,
  despite intensive efforts at contact tracing. The
  roommate's visitor subsequently developed Ebola,
  visited multiple doctors and hospitals via 12
  taxis, and transmitted Ebola to his mother, a
  cousin, another person, and a taxi driver.
  Deliberate evasion of disease control
  interventions can hamper monitoring of contacts
  and identification of cases. In late July, on day
  4 of contact monitoring, a female contact of an
  Ebola patient in Conakry stopped adhering to
  provisions of the 21-day period of close
  community monitoring. The contact left the
  community and traveled widely through several
  areas of the adjacent Forécariah prefecture by
  multiple motorcycle taxis. She visited a
  traditional healer and might have crossed into
  Sierra Leone before Ebola was diagnosed and she
  was isolated in an Ebola treatment unit on day
  16. Contact identification for this patient was
  particularly challenging, because she provided
  inconsistent information. Obscure transmission
  chains might reveal weaknesses in surveillance or
  hidden reservoirs of disease. In August 2015, an
  Ebola case was diagnosed through routine
  postmortem swab surveillance in Forécariah
  prefecture. Although health officials initially
  thought this case resulted from contact with a
  recently deceased relative who was buried
  secretly, molecular sequencing demonstrated a
  likely chain of transmission from a different
  community. Delayed consideration of Ebola as a
  cause of illness or death can lead to
  transmission and sometimes reintroduction of the
  virus into areas where transmission was
  previously interrupted. In late July, a man
  traveled from Freetown to Tonkolili District in
  Sierra Leone for a religious event. He sought
  care at two facilities, where he potentially
  exposed many health care workers and ultimately
  died. Ebola was confirmed by postmortem swab,
  ending the district's 150-day period without an
  Ebola case.

13
Eleven more MERS cases in Saudi Arabia, 2 in
Jordan

• Saudi Arabia's health ministry reported 11 more
  MERS-CoV cases in the past 3 days, 9 of them in
  Riyadh where a hospital-linked outbreak is under
  way, and Jordan's media is reporting 2 more
  cases, pushing the number of recently detected
  cases there to 6. Disease activity in Jordan and
  in neighboring Saudi Arabia are raising concerns,
  coming just weeks ahead of the busy international
  travel season surrounding the Hajj religious
  observance in Saudi Arabia. In separate
  announcements over the past 3 days, Saudi
  Arabia's Ministry of Health (MOH) reported 11 new
  lab-confirmed cases, 9 in Riyadh, 1 in Ha'il in
  the north central part of the country, and 1 in
  Najran, a city in the southern part of the
  country that has now reported four cases since
  early August.
• The country also reported 7 more MERS deaths, 6
  in Riyadh and 1 in Najran. All but one of the
  deaths involved previously announced patients.
• Of the 9 new cases in Riyadh, 8 likely have links
  to the hospital outbreak centered at King
  Abdulaziz Medical City, a large National Guard
  hospital in the city. Seven of the 8 patients
  were contacts of a suspected or confirmed
  MERS-CoV case in the hospital or in the
  community, and the contact status is still under
  review for the eighth patient. Source
  http//www.cidrap.umn.edu/news-perspective/2015/08
  /eleven-more-mers-cases-saudi-arabia-2-jordan

14
Cucumber-linked Salmonella outbreak total climbs
to 341

• The US Centers for Disease Control and Prevention
  (CDC) said today that 56 more illnesses have been
  reported in a multistate Salmonella Poona
  outbreak linked to cucumbers imported from
  Mexico, raising the total so far to 341 cases.
• Three more states (Hawaii, Kentucky, and
  Pennsylvania) have reported cases, lifting the
  number of affected states to 30. One more person
  has died from their illness, a patient from
  Texas, putting the fatality count at two.
  Meanwhile, the number of people who have been
  hospitalized for their infections has climbed
  from 53 to 70, or 33 of cases with available
  information.
• The CDC announced the outbreak linked to
  cucumbers distributed by Andrew Williamson
  Fresh Produce, based in San Diego, on Sep 4. On
  the same day the Food and Drug Administration
  posted a recall notice, which noted that the
  products had been distributed to at least 22
  different states, and perhaps others.
• In its update today, the CDC said a handful of
  states have made progress with testing the
  cucumbers for Salmonella. Nevada's health
  department has isolated one of the outbreak
  strains on samples from retail cucumbers, and
  Arizona and Montana have isolated Salmonella from
  similar samples, with DNA fingerprinting under
  way to determine the subtype. Tests on Salmonella
  isolated by San Diego health officials on
  cucumbers from the company's produce facility are
  still under way.
• Source http//www.cdc.gov/salmonella/poona-09-15/
  index.html